TAVI-first strategy noninferior to a PCI-first strategy in patients with severe aortic stenosis and concomitant CAD
A TAVI-first strategy was noninferior to a PCI-first strategy after one year's follow-up, according to results presented in a Hot Line session at ESC Congress 2026 and published simultaneously in the New England Journal of Medicine.
The TAVI-first strategy was found to be noninferior to a PCI-first strategy in patients with severe aortic stenosis and concomitant coronary artery disease, according to results from a randomized, noninferiority trial conducted at 48 centers across Europe. The study, presented at ESC Congress 2026 and published in the New England Journal of Medicine, included 986 patients with a mean age of 82 years.
The primary endpoint, which included all-cause death, nonfatal myocardial infarction, ischemia-driven revascularization, valve-, procedure- or heart failure-related rehospitalization, or life-threatening, disabling or major bleeding at one year, occurred in 22.2% of patients in the TAVI-first group and 24.2% in the PCI-first group.
There was no significant difference between the two groups, and the individual components of the primary endpoint were generally similar. Interestingly, fewer patients in the TAVI-first group ultimately underwent PCI, which was not due to impaired coronary access after TAVI but rather a change in clinical decision-making after the valve treatment.
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